Notes

CT Scan

Head CT Non-contrast Best initial for Head trauma (w/ LOC or altered mental status) Stroke Any intracranial bleeding (also most accurate) With contrast Best initial for Any intracranial mass lesion Cancer Infection/Abscess Abdominal CT With IV and oral contrast Best initial for Retroperitoneal structures (pancreas) Intraabdominal infection (appendicitis) Intraabdominal...

X-Ray

Chest X-Ray PA Best initial for any pulmonary sign or symptom Bowel perforation → Air under diaphragm AP If patient can’t stand up Decubitus Pleural effusion → Mobile fluid after PA Apical lordotic Not good for anything In TB: get chest CT instead Lateral Best initial for effusion Precise location of...

Polycystic Ovarian Syndrome

Risk Factors Familial Valproic acid Presentation Amenorrhea Irregular menses Infertility Hirsutism Androgenic alopecia Obesity Acne Metabolic syndrome Insulin resistance DM type 2 Acanthosis nigricans Atherogenic dyslipidemia Hypertension Diagnosis Rotterdam Criteria (2 out of 3) Polycystic ovaries on U/S Bilateral enlarged ovaries, multiple cysts Anovulation/Oligoovulation History of Amenorrhea Clinical/Biochemical hyperandrogenism...

Uterine Abnormalities

Fibroids Etiology Leiomyoma → Smooth muscle and connective tissue Estrogen-responsive → Change with cycles Non-malignant Risk factors Estrogen-responsive Change with cycles Shrink with menopause Black > White Presentation Uterine bleeding Menometrorrhagia Anemia Mass effect Enlarged uterus Constipation Urinary retention/frequency Pain Dysmenorrhea Dyspareunia Diagnosis Physical exam Firm, nontender, irregular, enlarged...

Contraception

Best Methods What’s in it? Duration The Good The Bad Implanon Progestin only 3 years Light period Breastfeeding Ok Irregular periods Weight gain IUD (Levonorgestrel) Progestin 5 years Light period ↓ cramps Breastfeeding Ok ↑ EP risk PID IUD (Copper) 10 years Breastfeeding Ok ↑ cramps/bleeds ↑ EP risk...

Uterine Bleeding

PALM COEIN Structural Polyp Adenomyosis Leiomyoma (Fibroids) Malignancy Non-structural Coagulopathy Ovarian Dysfunction (AUB) Endometrium Iatrogenic (IUD) Not yet classified Abnormal Uterine Bleeding Type Description Etiology Menorrhagia Heavy bleeding Endometrial hyperplasia Uterine fibroid DUB IUD Hypomenorrhea Light bleeding/Spotting Hymen Cervical stenosis OCP Oligomenorrhea Menstrual cycle >35 d Pregnancy Menopause Anorexia...

Menopause

Permanent loss of estrogen 48-52 years Average 12 months Symptoms Menstrual irregularity Sweating Hot flashes Mood changes Insomnia Anxiety/Irritability Poor concentration Dyspareunia Loss of libido Vaginal atrophy Vaginal pruritus Vaginal dryness Physical Exam Atrophic vaginitis ↓ Breast size Vaginal/cervical atrophy Diagnosis NO test needed! ↑FSH ↑LH ↑ Total cholesterol...

PMS/PMDD

Symptoms Headache Breast tenderness Pelvic pain Bloating Irritability Low energy Diagnosis Menstrual Diary Premenstrual Dysphoric Disorder Symptomatic for 2 consecutive cycles First half symptom free; Second half with symptoms Dysfunction in life Treatment Limit coffee, alcohol, cigarettes, chocolate Exercise Severe → SSRI

Psychiatric Hx and ex: Depression

Adolescent Hx and DD in practice case

Adolescent Weight loss Anorexia Nervosa Depression/anxiety Hyperthyroidism DM Cancer 

Notes to read CIS

Mini-Mental Status Exam

Category Points What to ask Orientation to time 5 Year, Season, Date, Day, Month Orientation to place 5 Country, State, Town, Hospital, Floor Registration 3 Name 3 objects immediately (Chair, Bed, Pen) Concentration 5 Serial 7’s: 93, 86, 79, 72, 65 or Spell WORLD backward Recall 3 Name 3...